PROJECT SUMMARY Individuals experiencing limited English proficiency use emergency departments (EDs) more frequently than their English-proficient counterparts; however, this research largely excludes individuals who are Deaf and hard-of-hearing (DHH). DHH patients are at risk of being limited English-proficient, and experience unique barriers to effective patient-provider communication and healthy living. Health services research focusing on this population is scarce but indicates that DHH adults are at higher risk than their hearing English-speaking counterparts of using the ED for less emergent conditions. Importantly, the majority of research on DHH health disparities is from Rochester, NY; Rochester has one of the highest per capita populations of DHH people, who likely have higher educational attainment and more access to healthcare than the broader Deaf community. Even in this more optimal setting, disparities in ED utilization have been observed; yet, there has not been further investigation of the extent of this disparity in more representative contexts. The lack of an empirical, holistic understanding of the unique factors influencing ED utilization among DHH patients represents a critical barrier to progress in the field, and hinders efforts to improve care and reduce health disparities for DHH patients. Thus, the purpose of this study is to develop and refine a conceptual model of ED utilization among DHH patients which will allow us to gain a more in-depth understanding of this population?s health behavior. Our research design is multistage: we start with a critical literature review to develop a preliminary conceptual model, and then revise this model from evidence obtained through an explanatory sequential mixed methods study. The specific aims are to: 1) conduct a critical review of the peer reviewed and gray literature to develop a preliminary conceptual model of DHH patient ED utilization; 2) evaluate differences in ED utilization and presenting clinical characteristics among DHH and hearing patients through a retrospective chart review of patient electronic medical records; 3) qualitatively assess ED utilization and experience perspectives among DHH patients and ED providers; and, 4) integrate the findings from Aim 2 and 3 through mixed methods integrative data analysis to revise the conceptual model. This proposal directly responds to AHRQ?s priority area of harnessing data to gain a 360-degree view of patient outcomes among members of an AHRQ-identified priority population (i.e., individuals with special healthcare needs ? people with disabilities). The expected outcome of this study will be a conceptual framework that can be used to identify intervention targets to improve healthcare delivery and ensure efficient healthcare utilization for the 55 million DHH patients in the U.S.